For brain injury clinicians like me, the suicide of 23-year old Olympic cyclist and Stanford engineering student Kelly Catlin last weekend struck with special force. A brilliant, fiercely competitive, and driven young woman, she suffered a concussion in a fall last December. Quoted in The Washington Post newspaper, her father Mark Catlin blamed her death on that injury and his daughter’s inability to let herself slow down enough to let her brain heal. “For her,” he said, “she could no longer concentrate on her studies or train as hard. She couldn’t fulfill what she felt were her obligations to herself, she couldn’t live up to her own standards. She couldn’t realize that what she needed to do was get away and rest, heal.”
During my career as an occupational therapist, I have worked with many young people who have suffered concussions. Some, like Ms. Catlin, were hard-charging Type A individuals, 4.0 students, and athletes. The consequences of mild traumatic brain injury turned their worlds upside down.
What are those consequences? Concussion symptoms can fill books, and do. Headache, double vision, and balance difficulties are the most obvious problems, but the less visible symptoms can be the most insidious and difficult to manage: impaired memory, attention challenges, sleep disorders, mood swings, and a feeling that, as one of my clients described it, “my mind just feels cloudy all the time.”
When I meet with a client for the first time, we go over a page long symptom checklist, because every person with a brain injury has an individualized set of problems. But the one all of them seem to share is “slowed cognitive processing.” The computer between our ears, which spends most of its time doing background work we never notice — filtering sensory information so we can focus on our tasks at hand — becomes overwhelmed because of its damaged circuits. Like a dam-burst, the everyday world of sights, noises, and smells pours in, and the flooded brain chokes on the information overload. Ms. Catlin, like so many of my clients, was a champion multi-tasker at school, and she could maintain a razor-sharp focus during her sports training. Brain injury attacked her very identity, assaulting the skills that made her the brilliant engineering student and Olympic athlete that she was.
For the brain to heal, it’s important to reduce the sensory stimulation that makes it work so hard. After a concussion, people must learn to pace and incrementally increase their physical and cognitive workloads. Immediately after injury, watching television or playing a video game can overwhelm the brain, bringing on crushing fatigue or other symptoms. Gradually, over weeks, I counsel my clients to increase their physical and cognitive effort, using their symptoms as a guide. Can you walk around the block without getting a headache? If so, maybe you’re ready to try jogging. Can you read a chapter in a book and summarize what you’ve read? If so, maybe you’re ready to sit in a classroom for an hour. For Type A individuals and super-athletes, slowing down is the hardest thing they’ve ever done. It goes against everything they know about success. Sometimes I compare a damaged brain to a broken leg. It’s an awkward comparison, but imagining a brain in a cast can help clients follow my advice. You wouldn’t try to run on a broken leg, I tell them. Give your brain both physical and cognitive rest. Let it heal.
A million Americans visit emergency rooms each year with mild traumatic brain injuries. Most fully recover in three to six months if they can take the slow, progressive steps that give the brain a chance to recover. Some people continue to have symptoms beyond that window and must learn to cope with a brain that works more slowly. Sadly, we will never know whether Kelly Catlin would have healed; her life ended only three months after her fall.